Provider First Line Business Practice Location Address:
1090 UNIVERSITY AVE STE 207G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-7308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-458-9626
Provider Business Practice Location Address Fax Number:
619-228-9061
Provider Enumeration Date:
12/18/2017